Introduction. The obstetricians attitudes towards caesarean delivery at the threshold of viability were explored in a European project (EUROBS) in eight countries: France, Germany, Italy, Luxembourg, Netherlands, Spain, Sweden and the UK.Methods. In each country, NICU-associated obstetrical units were selected through census or random sampling. An anonymous self-administered questionnaire explored the obstetricians attitudes regarding the lowest gestational age at which they would perform a caesarean delivery in case of acute foetal distress of a single, non-malformed and normally grown fetus given that: a) parents want everything possible done to save the baby; b) parents favour non-aggressive management for fear of disability; and c) the obstetrician him/herself is one of the parents. Data collection took place in [2001][2002]; 105 units and 1530 obstetricians participated (response rates 70% and 77% respectively).Results. At 24 weeks of gestational age, 71% of the German, 52% of the Swedish, and 27% of the Italian and British obstetricians would perform a caesarean delivery given parental agreement, compared with only 17% of the French, 14% of the Spanish, and less than 1% of the Dutch ones. The intervention would be postponed by an average of 3.8 days (95% CI 2.9 -4.7) in case of parental opposition to active management, and by 5.7 days (95% CI 4.1-7.3) if the obstetrician was one of the parents. Other factors significantly associated with a more advanced caesarean section threshold in a multivariate model were older age, being a woman, muslim and oriental religion, more pessimistic beliefs regarding neonatal prognosis, and consultation with neonatologist.Conclusions. The lowest gestational age at which obstetricians would perform a caesarean delivery for fetal indication only varies according to country, parental views, and personal physician characteristics and beliefs. These findings have implications for neonatologists subsequent actions, and for the international comparison of perinatal statistics.
There are a lot of publications about fetal arrhythmia in singletons, but up to now there are no published data about fetal arrhythmia in multiple pregnancies. In the present study a case history of fetal and neonatal arrhythmia in one of twins from two mothers treated with betamimetic agents due to imminent preterm labor is reported and discussed. A first case with fetal bradycardia due to complete A-V block had congenital cordis abnormalities (VSD and PFO). The second case with prenatal detected extrasystoles had normal heart anatomy. Digoxin was administered to the mother, in the aim to treat fetal arrhythmia without success, because the baby had postnatal bradycardia. After hospitalisation in Cardiology Department the described cases were successfully treated. In both cases the second twins were without neonatal arrhythmia and with no structural heart abnormalities. We summarise that in situation of detection fetal arrhythmia the complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.
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